How Much Does Ot Evaluation High Complex 60 Minutes Cost?
Also known as: Ot eval high complex 60 min (CPT 97167)
Ot Evaluation High Complex 60 Minutes (CPT 97167) costs $101 at Medicare rates.
Procedures Commonly Done Together
These procedures are frequently performed alongside Ot eval high complex 60 min
How to Reduce Your Cost for Ot eval high complex 60 min
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (3.01) x CF ($33.40) = $101
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Ot eval high complex 60 min cost?
The Medicare facility rate for Ot eval high complex 60 min is $101. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Ot eval high complex 60 min cost without insurance?
Without insurance, the cost of Ot eval high complex 60 min can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Ot eval high complex 60 min?
Most commercial health insurance plans and Medicare cover Ot eval high complex 60 min when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.